E-prescribing

Synopsis

The CMA surveyed e-Panel members to learn more about their views on e-prescribing, a tool developed to increase medication safety and adherence, quality collaboration between physicians and pharmacists, and overall health system tracking and performance. The results provide a picture of respondents’ preferred methods of prescribing and the obstacles that prevent them from generating scripts electronically, as well as potential improvements for this tool. A summary of the results of the e-Panel survey is presented below.

Survey – June 2014

The survey was sent to 2,799 e-Panel members; 404 responded, for a response rate of 14%.

Definitions

E-prescribing: The secure electronic creation and transmission of a prescription between an authorized prescriber and a patient’s pharmacy of choice, using clinical Electronic Medical Record (EMR) and pharmacy management software.

Auto-fax: A prescription generated by a prescribers’ electronic medical record (EMR) system or computer and sent to a pharmacy fax, with a computer generated prescriber signature.

Fax: A prescription that is printed by a prescribers’ electronic medical record (EMR) system or computer, that has been signed individually by the prescriber before it is faxed to the pharmacy.

Printout: A prescription that is printed by a prescribers’ electronic medical record (EMR) system or computer, that has been signed individually and given to the patient to take to their pharmacy.

Results

Survey results indicate that e-prescribing is not commonly used by respondents; only 7% reported using it. Other methods of prescription were more frequently reported by respondents. E-prescribing is not uniformly available across the health care system and where it is available, only some respondents wish to use it. Although this tool presents potential benefits to physicians and their patients, respondents face significant challenges with its use.

Prescription frequency and methods

Respondents’ answers varied when asked how many prescriptions they generate per day: 34% generate less than 10; 35% generate between 10 and 20; 29% generate more than 20; and 2% do not issue prescriptions. Respondents reported using a variety of methods for prescribing; results below are ranked from highest to lowest reported use:

Telephone (e.g. physician/prescriber calls) (75%)

Handwritten and given to patient (68%)

EMR/Computer generated Printout (59%)

Handwritten and faxed to pharmacy (53%)

EMR/Computer generated Fax (26%)

EMR/Computer generated Auto-fax (14%)

E-prescribing (7%)

Other (7%)

Prescription sent to an electronic provincial Drug Information System (DIS) (3%)

Most respondents (76%) never generate auto-faxed/printed prescriptions with electronic signatures. Of the ones who do, there is varying frequency with which they receive requests from pharmacies to verify the electronic signature, with 32% saying never, 28% saying rarely, 26% saying sometimes, 6% saying frequently, and 8% saying most or all of the time.

Prescription Tools

Participants reported using a variety of tools for patient care, although these are not accessible for all:

electronic reminders for recommended patient care are most commonly used on an electronic medical record (34%), and are unavailable or inaccessible for 52% of respondents;

drug Information and management software are most commonly used on an electronic medical record (34%), and are unavailable or inaccessible for 30% of respondents;

electronic clinical decision support tools are most commonly used on mobile devices (38%), and are unavailable or inaccessible for 33% of respondents;

electronic lists of all medications taken by an individual patient are most commonly used on an electronic medical record (28%), and are unavailable or inaccessible for 47% of respondents;

electronic warnings for adverse drug interactions or contraindications are most commonly used on an electronic medical record (41%), and are unavailable or inaccessible for 44% of respondents;

electronic access to laboratory test results is most commonly used on an electronic medical record (73%), and is unavailable or inaccessible for 16% of respondents; and

electronic transfer of clinical/patient medical information securely to/from other health professionals are most commonly used on an electronic medical record (25%), and are unavailable or inaccessible for 66% of respondents.

Use of Electronic Provincial Drug Information Systems (DIS)

The majority of respondents (57%) say that their practice never accesses an electronic provincial drug information system (DIS), while the remaining respondents access one ranging from several times a month (8%) to every patient (6%). The most common reason for never accessing an electronic provincial DIS is not having access to one. The time since beginning to use a DIS varies, with 23% using it for less than a year, 28% for 1-2 years, 28% for 2-5 years, and 21% for 6 years or more. Most respondents (56%) report that these systems provide them with the required patient information they need to perform their practice. The most popular way (43%) to access the DIS is through the web viewer, followed by integrated in local EMR (16%), other (16%), launch button from EMR (14%), and third-party application (12%).

Benefits of e-prescribing

The most popular benefits cited by respondents for e-prescribing were:

Error reduction and improved patient safety

Reduced possibility of forgeries and tampering

Improved accuracy of record keeping, linkage to EMRs

Increased legibility

Speed and convenience

Security and privacy

Challenges of e-prescribing

The most common challenges cited by respondents for e-prescribing were:

No access to e-prescribing

Lack of pharmacy capability (39% never encounter pharmacies with ability to receive and authenticate prescriptions generated by electronic means)

Difficulty in coordinating with pharmacies (e.g. pharmacies that request proof of signature, lack of confirmation that prescription was sent/received)

Issues with technology and system malfunctioning

Time commitment

Security and privacy

Cost

Respondents told us (selected comments about e-prescribing)

“I can't wait for proper, easy to use prescribing with electronic transfer of the prescription to the pharmacy. It's past time. I work in really remote areas - Baffin Island, Baker Lake - internet and telephone are irratic, or at best cannot be completely relied upon.”

“Secure, safe, rapid prescriptions that can't be tampered with or lost. From working elsewhere (as I haven't had it here): improved accuracy on drug doses/intervals; ease of reviewing what a patient is actually on at any given time; warning of potential drug interactions.”

“Vastly improved efficiency and accuracy of refills as well as interaction generating assistance from the EMR.”

“I have never used this way of prescribing medications. We can write prescriptions in our electronic record. They are then printed and given to the patient. Issues would include compatibility between the EMR and Pharmacy software; lack of appropriate connectivity between my office and my EMR at the hospital clinic; payment for writing electronic prescriptions.”

“Willingness of pharmacists to 'play ball' (including regulatory body), lack of ability to even use 'fax generation' for 'triplicate' items like narcotics, lack of provincial EMR/pharmacy information network progress in this area.”

“Nothing major - it's really great. Some (very few) pharmacists get very finicky in how they want these Rx's presented as compared to others. Legible and fast. Convenient for me and my patients. love it!!”

“Time; Time; Time: The time spent searching the EMR data-base for the med, the dose- ie sig & mitte tends to be exceedingly long. Creation of personalized 'favourite lists' are certainly helpful but it will never be faster than writing the script.”

“I think we are rushing to electronic record keeping too quickly without really addressing privacy and confidentiality issues. All Health care providers do not need to have access to all this information, and the potential abuses are being ignored.”

“…Maybe if there was a province wide system such as in NFLD. It might interest me if it did not cost me money.”